Description of an integrated framework for building linkages among primary care clinics and community organizations for the prevention of type 2 diabetes: emerging themes from the CC-Link study

Abstract

Strong clinic-community linkages are pivotal for the success of preventive services that combine clinical and community resources. Unfortunately, there has been limited guidance for how clinical and community groups can partner to improve self-care and prevention for chronic conditions. This manuscript describes the development and implementation of an integrated framework to guide clinic-community linkages for the prevention of type 2 diabetes in an ongoing randomized effectiveness trial known as Clinical-Community Linkages to Prevent Diabetes (CC-Link) study. This study involves 10 primary care practices in a metropolitan area of the Midwest US. The study provided each practice location with technical assistance to select, implement, evaluate and refine different strategies to identify and address pre-diabetes using a clinic-community linkage. Sites were also randomized to receive either direct or indirect involvement by a community liaison/expert from the YMCA of Greater Indianapolis. Early implementation of the CC-Link Framework has underscored the importance of strong leadership and partnership synergy, and it uncovered several examples of how linkages can be designed to make the most of partner strengths. This success is promising, and an evaluation of the effectiveness of these efforts to improve lifestyle behaviours of adults with prediabetes is now underway.

Keywords

Chronic Disease/Prevention and Control Evidence-Based Practice Healthcare Healthcare Reform Prediabetic State Primary Prevention Primary Healthcare Public-Private Sector Partnerships Quality Assurance

Get full access to this article

View all access options for this article.

References

Rittenhouse DR , Shortell SM

The patient-centered medical home: will it stand the test of health reform?

JAMA 2009 ; 301: 2038-40.

Woolf SH A closer look at the economic argument for disease prevention. JAMA 2009; 301: 536-38.

Mokdad AH , Marks JS , Stroup DF , Gerberding JL Actual causes of death in the United States, 2000. JAMA 2004; 291: 1238-45.

Mokdad AH , Marks JS , Stroup DF , Gerberding JL Correction: actual causes of death in the United States, 2000 . JAMA 2005; 293: 293-94.

Grumbach K. , Bodenheimer T. A primary care home for Americans: putting the house in order. JAMA 2002; 288: 889-93.

Avenell A. , Broom J. , Brown TJ , et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 2004; 8: iii-iv, 1-182.

McTigue KM , Harris R. , Hemphill B. , et al. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003; 139: 933-49.

Whitlock EP , Orleans CT , Pender N. , Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med 2002; 22: 267-84.

Yarnall KS , Pollak KI , Ostbye T. , Krause KM , Michener JL

Primary care: is there enough time for prevention?

Am J Public Health 2003; 93: 635-41.

10.

Etz RS , Cohen DJ , Woolf SH , et al. Bridging primary care practices and communities to promote healthy behaviors. Am J Prev Med 2008; 35: S390-97.

11.

Ncoa. Partnering Physicians with Community Organizations, 2005 (accessed October 15, 2009).

12.

Woolf SH , Glasgow RE , Krist A. , et al. Putting it together: finding success in behavior change through integration of services. Ann Fam Med 2005; 3: S20-27.

13.

Cdc. Guide to Community Preventive Services, 2009. Available at: http://www.thecommunityguide.org/ (accessed October 15, 2009).

14.

Bodenheimer T. , Wagner EH , Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA 2002; 288: 1909-14.

15.

Bodenheimer T. , Wagner EH , Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002 ; 288: 1775-79.

16.

Glasgow RE , Orleans CT , Wagner EH

Does the chronic care model serve also as a template for improving prevention?

Milbank Q 2001; 79: 579-612, iv-v.

17.

Wagner EH , Austin BT , Von Korff M. Organizing care for patients with chronic illness. Milbank Q 1996; 74: 511-44.

18.

Gillies CL , Abrams KR , Lambert PC , et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 2007; 334: 299.

19.

Narayan KM , Williamson DF Prevention of type 2 diabetes: risk status, clinic, and community . J Gen Intern Med 2010; 25: 154-7.

20.

Williamson DF , Narayan KM Identification of persons with dysglycemia: terminology and practical significance. Prim Care Diabetes 2009; 3: 211-17.

21.

Mitchell SM , Shortell SM The governance and management of effective community health partnerships: a typology for research, policy, and practice . Milbank Q 2000; 78: 241-89, 151.

22.

Cheadle A. , Beery W. , Wagner E. , et al. Conference report: community-based health promotion-state of the art and recommendations for the future. Am J Prev Med 1997; 13: 240-43.

23.

Lasker RD , Weiss ES , Miller R. Partnership synergy: a practical framework for studying and strengthening the collaborative advantage. Milbank Q 2001 ; 79: 179-205, III-IV.

24.

Weiss ES , Anderson RM , Lasker RD Making the most of collaboration: exploring the relationship between partnership synergy and partnership functioning. Health Educ Behav 2002; 29: 683-98.

25.

Ahrq. Put prevention into practice. A step by step guide to delivering clinical preventive services: a systems approach (AHRQ Publication No. APPIP01-0001), Rockville, MD: AHRQ.

26.

Hrsa. Health Disparities Collaboratives Knowledge Gateway. 2009. Available at: www.healthdisparities.net/hdc (accessed October 15, 2009).

27.

IHI. Topics in Healthcare Improvement . 2009. Available at: www.ihi.org/ihi/topics (accessed October 15, 2009).

28.

Soumerai SB , Avorn J. Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA 1990; 263: 549-56.

29.

Bonomi AE , Wagner EH , Glasgow RE , VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res 2002; 37: 791-820.

30.

Magnan S. , Solberg LI , Giles K. , Kottke TE , Wheeler JW Primary care, process improvement, and turmoil. J Ambul Care Manage 1997; 20: 32-38.

31.

Solberg LI , Kottke TE , Brekke ML , Magnan S. Improving prevention is difficult. Eff Clin Pract 2000; 3: 153-55.

32.

Solberg LI , Kottke TE , Brekke ML , et al. Failure of a continuous quality improvement intervention to increase the delivery of preventive services. A randomized trial. Eff Clin Pract 2000; 3: 105-15.

33.

Tynan A. , Draper DA Getting what we pay for: innovations lacking in provider payment reform for chronic disease care. Research Briefs No. 6, 2008: 1-8.

34.

IHI. Improvement Stories . 2009. Available at: http://www.ihi.org/IHI/Results/ImprovementStories/ (accessed October 15, 2009).

35.

Ncqa Measuring quality. Improving health care. 2009. Available at: www.ncqa.org. (accessed October 16, 2009).

36.

Rwjf. Aligning forces for quality. 2009. Available at: http://www.rwjf.org/qualityequality/af4q/index.jsp (accessed October 15, 2009).

37.

Shojania KG , McDonald KM , Wachter RM , Owens DK Closing the quality gap: a critical analysis of quality improvement strategies, Volume 1-Series overview and methodology. Technical review 9 (Contract No. 290-02-0017 to the Stanford University-UCSF Evidence-based Practices Center). AHRQ Publication No. 04-0051-1, Rockville, MD: Agency for Healthcare Research and Quality, 2004.

38.

Thomas P. , While A. Increasing research capacity and changing the culture of primary care towards reflective inquiring practice: the experience of the West London Research Network (WeLReN). J Interprof Care 2001; 15: 133-39.

39.

Cohen D. , McDaniel Jr RR , Crabtree BF , et al. A practice change model for quality improvement in primary care practice. J Healthc Manag 2004; 49: 155-68; discussion 169-70.

40.

Feifer C. , Ornstein SM Strategies for increasing adherence to clinical guidelines and improving patient outcomes in small primary care practices. Jt Comm J Qual Saf 2004; 30: 432-41.

41.

Hroscikoski MC , Solberg LI , Sperl-Hillen JM , Harper PG , McGrail MP , Crabtree BF Challenges of change: a qualitative study of chronic care model implementation. Ann Fam Med 2006; 4: 317-26.